In your clinical practice, imagine that tomorrow you are dealing with a patient with recent pleural pain and multiple pleural nodules suggesting cancerous lesions in the posterior region of the left hemithorax. However, the positron emission tomography scan does not favour malignancy. In your list of aetiological diagnoses, will you raise the possibility that the previous history of abdominal injury in your patient may have led to thoracic splenosis? How will you confirm this diagnosis? What is the treatment?
This example is the beginning of the answer to the following question: why write a book about pleural diseases? First, physicians and, in particular, pulmonologists are challenged with the aetiological diagnosis of pleural diseases, often pleural effusions, on a daily basis. Pleural effusions complicate many different pulmonary diseases and infections. Unfortunately, pathologies of the pleura are not covered in sufficient detail in books on pulmonary disease.
Secondly, apart from pleural effusion, physicians are not comfortable in diagnosing other pleural diseases, such as pleural fibrosis, infrequent pleural infections, or rare primary malignant and benign pleural tumours.
Finally, techniques for the diagnosis and management of pleural diseases have evolved over the past 10 years; however, with considerable variations in practices between countries and centres, thus sometimes making decisions uncomfortable and even dangerous.
The 6th edition of Pleural Diseases has been written by a single author, Richard W. Light. I guess there is no need to introduce Prof. R.W. Light. He has been a leader in the field of pleural diseases for many years. Worldwide, medical students have learned the famous Light’s criteria used for the discrimination between transudative and exudative pleural effusion.
The strength of this book lies in its very comprehensive approach to pleural diseases and the technical approaches it presents. That being said, some very new aspects and entities, such as the recently described pleuroparenchymal fibroelastosis, although described in the book, could have been covered even more thoroughly. The first five chapters of the book nicely discuss anatomy, physiology, imaging, biology and current research in the field. The anatomy and physiology of the pleura are treated rather superficially during medical training and are much more complicated than they appear. A quick survey in my own department demonstrated that junior and even senior physicians often have limited knowledge of this field. A whole chapter on the cytokines involved in pleural processes highlights the multipotent functions of the fascinating mesothelial cells, which can not only produce, but also respond to, various stimuli after cytokine overexpression. Later in the book, R.W. Light explains his rigorous diagnostic approach for pleural effusion depending on the clinical conditions and analysis of the pleural fluid. Then, in the following 18 chapters we learn about every disease state found in pleural diseases. In these chapters, you can find answers to many of the clinical problems you might encounter. The last three chapters of the book focus accurately on technical and therapeutic approaches (thoracocentesis, chest tubes and thoracoscopy) and highlight novel techniques in this field.
The book comes with online access for individual use but also the possibility to obtain multi-user access. I really enjoyed reading this book, which covers, in a very practical approach, many aspects of pleural diseases.
- ©ERS 2014